Active and Former Injection Drug users Report of HIV Risk Behaviors during Periods of Incarceration

Abstract

American prisons have increasing numbers of inmates incarcerated for drug offenses. This population is at high risk for HIV-infection and may continue HIV transmission risk behaviors while incarcerated. We find that 31% of injection drug users with a history of imprisonment had used illicit drugs in prison, and nearly half of these persons had injected drugs while incarcerated. Male gender and number of times incarcerated were associated with drug use in prison. Interventions for drug-using prisoners that are advocated in some European prisons, such as needle exchange programs and methadone maintenance, need attention in the United States.

Attitudes and Practices Regarding the Use of Methadone in US State and Federal Prisons

“…Methadone treatment that is initiated shortly prior to release aims to link inmates to effective community treatment. Although it is clear that high-risk behaviors occur in incarcerated settings 38,[45][46][47] and that reduction in risk behavior can occur with the use of methadone, 39 variability of prison systems and settings in different regions may imply that optimal methadone treatment policies should be tailored to local conditions. Providing MMT for inmates who were treated in community clinics prior to incarceration or initiating MMT in the incarcerated setting may also be an effective strategy to prevent HIV and hepatitis transmission in settings where high-risk behaviors are prevalent [46][47][48] and where effective linkage to community-based treatment exists for the post-release period.…”

Substance Use and Sexual Behavior during Incarceration among 18- to 29-Year Old Men: Prevalence and Correlates

“…Elevated rates of hepatitis and other sexually transmitted infections (STIs) among correctional populations also have been reported (Baillargeon, Black, Pulvino, & Dunn, 2000;Mertz et al, 2002). Men entering correctional settings often report behavior prior to incarceration that placed them and their partners at considerable risk for HIV, hepatitis, and other STIs, including unprotected sex with multiple and high-risk sex partners, sex and substance use co-occurrence, and injection drug use with needle sharing (Chen et al, 2002;Clarke, Stein, Hanna, Sobota, & Rich, 2001;Conklin, Lincoln, & Turnhill, 2000;MacGowan et al, 2003;Margolis et al, 2006).…”

From Corrections to Communities as an HIV Priority

“…Since these early studies were published, additional reports have been published showing sex within prison is more widespread than previously appreciated, 32 and rates of injection drug use inside prison can be as high as 30%. 33,34 More to the point, given that HIV infection is observed among entering inmates, that behaviors occur within prison that facilitate transmission of infection, and that the average length of sentence is three years, 35 do prisons serve as amplifying reservoirs of infection back into the surrounding community? The theoretical concern that prisons might serve as amplifying reservoirs of HIV infection back into the community has excited considerable discussion.…”